Traumatic Occlusal Forces Flashcards by sophie rosen

Other conditions affecting the
periodontium
(5)

Systemic diseases
Periodontal abscess or
periodontal/ endodontic lesions
Mucogingival deformities and
conditions
Traumatic occlusal forces
Tooth and prosthesis related
factors

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Occlusal Trauma (OT) Diagnosis

Injury resulting in tissue changes within the attachment
apparatus (periodontal ligament, cementum and supporting
bone) as a result of occlusal forces (etiology)

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Occlusal Trauma (OT) Diagnosis
Occlusal forces = !

Teeth

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Occlusal Trauma (OT) Diagnosis
May occur in an

intact periodontium or in a reduced
periodontium affected by periodontal disease

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What is a ‘reduced’ periodontium?
Based on an in vitro study, reduced is loss of —%
of bone support

> 60

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AAP World Workshop 2017
Occlusal trauma and excessive*
occlusal forces
Questions asked:
(2)

Does occlusal trauma (OT) initiate periodontal disease?
Does occlusal trauma lead to progression of existing
periodontal disease?

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AAP World Workshop 2017
Occlusal trauma and excessive*
occlusal forces
Questions asked:
* Does occlusal trauma (OT) initiate periodontal disease?
* Does occlusal trauma lead to progression of existing
periodontal disease?

*Point of interest-title of workshop includes —, but terminology is
changed to —

excessive
traumatic

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Why the Change?

Research performed for over 100 years but used different
animal models and experimental design (magnitude,
direction and location of forces)
* Sheep
* Human necropsy
* Beagles
* Squirrel Monkeys
Overall, past studies showed lack of ‘cause and effect’.
i.e. Occlusal Trauma (OT) did not cause pocket formation or
lead to loss of connective tissue.

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Parts of the Periodontium
Affected by Occlusal Forces

Cementum
PDL
Alveolar Bone Proper
The gingiva and junctional epithelium are not
affected by occlusal forces.

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Classification of Traumatic Occlusal Forces
on the Periodontium (2017)
1. Occlusal Trauma
(3)

A. Primary occlusal trauma
B. Secondary occlusal trauma
C. Orthodontic forces

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Occlusal Trauma
Variables:
(4)

Direction of force.
Magnitude of force.
Duration of force.
Frequency of occurrence

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Trauma From Occlusion
1. Considered to be —.
2. Forces of occlusion — the adaptive capacity
of the periodontium

pathologic
exceed

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Primary Occlusal Trauma 2017

Traumatic occlusal forces applied to a tooth or teeth
with normal periodontal support

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With Primary occlusal trauma, clinically may see

adaptive mobility (does not progress)

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Primary Occlusal Trauma 2017
Example is

‘high’ restoration with mobility resolving
following reduction.

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Secondary Occlusal Trauma 2017

Injury resulting in tissue changes from normal or
traumatic occlusal forces applied to a tooth or teeth
with reduced periodontal support
* May be seen as progressive mobility &/or pain

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Trauma from Occlusion
A. Compression side
(4)

PDL space is reduced as fibers are compressed
Loss of fiber orientation
Increased capillary permeability, rupture of blood
vessels and hemorrhage into PDL perivascular
spaces (edema)
Resorption of alveolar bone proper (root resorption
if severe) then widening of PDL space

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Minor Trauma (from occlusion)
(5)

Increased capillary permeability, dilation
Edema, disturbed fluid exchange
Vascular damage with stasis, clotting, thrombosis
Lowered periodontal resistance?
Accompanying tissue effects, usually minor

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Trauma from Occlusion
B. Tension side
(4)

Increase in PDL space
Rupture of PDL fiber bundles
Compression of PDL blood vessels and
hemorrhage into perivascular spaces
Deposition of new alveolar bone and decrease in
PDL space (If severe, cemental tears)

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Severe Trauma (from occlusion)
(5)

Crushing (pressure) injury - necrosis at furca, alveolar crest
Extravasated RBCs, hematoma, necrosis, vascular damage
Well-defined necrosis, including PDL, cementum, bone
Degenerative changes (hyaline, mucoid, liquefaction)
Repair from PDL, endosteal cells, bone marrow, Haversian
systems (rear resorption)

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Term: Primary Occlusal Trauma
Definition:
Manifestation:

Traumatic occlusal
forces applied to tooth
or teeth with NORMAL
periodontal support

Adaptive mobility (not
progressive or
pathologic)

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Term: Secondary Occlusal Trauma
Definition:
Manifestation:

Normal or traumatic
occlusal forces applied
to a tooth or teeth with
reduced periodontal
support

Progressive mobility
(may exhibit mobility
and/or pain on
function)
Consider splinting?

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Problem
The lesion of Occlusal Trauma can only be confirmed
—, so must use
other surrogate indicators
(2)

histologically by block section biopsy

Clinical
Radiographic

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Proposed clinical and radiographic indicators of
occlusal trauma
(11)

Fremitus (palpable or visible
movement of a tooth when subject to
occlusal forces)
Thermal sensitivity
Mobility
Discomfort/pain on chewing
Occlusal discrepancies (working
&/or balancing interferences)
Widened periodontal ligament space
Wear facets
Root resorption
Tooth migration
Cemental tear
Fractured tooth

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Fremitus

A palpable or visible movement of a tooth when subjected to occlusal forces.

Clinical Signs/Symptoms of Occlusal Trauma 1. --- of affected teeth.* 2. Radiographic evidence of --- 3. Positive Hx of --- 4. --- teeth. 5. Evidence of working and/or balancing side ---

Mobility thickened PDL. clenching or bruxism. Missing or tilted occlusal interferences

Mobility Assessment 1= 2 = 3 =

first distinguishable sign of movement > than normal (physiologic) movement which allows crown to move 1 mm from its normal position in any direction tooth may be rotated or depressed in alveoli

Mobility Assessment Must use

2 rigid instruments, NOT fingers

Occlusal Discrepancies (2)

* Working &/or balancing interferences * Wear facets (BUT may be normal part of aging!)

* Working &/or balancing interferences (3)

* Evidence of occlusal slide in CR or CO * Evidence of occlusal interferences in protrusive mandibular movement * Extremely steep cuspal inclines

Bruxism

Grinding, clenching or clamping of the teeth. * The force may damage tooth or attachment apparatus

Signs & symptoms of bruxism: (7)

* Increased mobility * Pulpal sensitivity / bite tenderness * Non-masticatory / excessive occlusal wear * Dull percussion sound * Muscle tenderness / spasm / hypertrophy / tiredness (am) * TMJ pain / jawlock * Audible sounds

Other Manifestations of Traumatic Occlusal Force (3)

* Malocclusions * Tooth migration * Fractured teeth

Radiographic Signs (5)

* Widened PDL space * Thickening of lamina dura * Vertical (angular) bone loss * Furcal bone loss * Alveolar radiolucency &/or condensation

Periodontal Ligament Dimensions * PDL thickest at --- Less at --- * Varies with ---

apices & alveolar crest (0.20 mm); mid-root (0.15 mm) functional / force status of tooth

Problems with surrogate indicators * Existing --- may contribute to mobility * --- may be due to ‘normal’ function rather than parafunctional habits (bruxism, clenching, grinding) * Altered --- of teeth may be due to other factors

loss of attachment Wear facets vitality

Indications for Occlusal Adjustment (4)

* Traumatic injuries / soft tissue injury; food impaction * Increasing mobility or fremitus * Parafunctional habits * In conjunction with orthodontic / orthognathic therapy

Contraindications to Occlusal Adjustment (5)

* Absence of a pre-treatment diagnosis * As prophylactic therapy or only treatment for periodontal disease * As primary therapy of bruxism * Severe extrusion or malpositioned teeth * When periodontal inflammation has not been controlled

Effect of Periodontal Treatment on Mobility Tooth mobility negatively affects outcome of Tooth mobility generally will decrease once

periodontal therapy and maintenance inflammation is controlled

‘Recommendations’ from Workshop * If see signs and symptoms of occlusal trauma and patient’s comfort and function are impacted then perform

occlusal adjustment in conjunction with periodontal therapy

* Evaluate and record --- before, during and after treatment

occlusion

* Treatment of occlusal trauma ‘may

slow the progression of periodontitis and improve the prognosis

Orthodontic Forces Animal studies- certain orthodontic forces can adversely affect the periodontium and cause (4)

root resorption, pulpal disorders, gingival recession and alveolar bone loss

Orthodontic Forces Observational studies-

teeth with a reduced but healthy periodontium (no inflammation) may undergo successful tooth movement without compromising periodontal support

Occlusal Hyperfunction 1. --- increase in occlusal force. 2. Considered to be a --- adaptation and not a --- entity

Slight physiologic pathologic

Clinical Symptoms of Occlusal Hyperfunction 1. Increase in number and diameter of --- 2. Increased --- 3. Increased density and thickness of --- 4. Radiographic evidence of ---. 5. Slight or undetectable tooth ---

collagen fiber bundles in PDL width of PDL. alveolar bone proper (lamina dura). osteosclerosis mobility

Occlusal Hypofunction (3)

1. A mild weakening of the tooth supporting structures due to lack of physiologic stimulation. 2. Considered to be a physiologic adaptation and not a pathologic entity. 3. Can only be diagnosed by histology

Occlusal Hypofunction 1. --- in number of PDL fiber bundles but normal orientation. 2. --- physiologic turnover and remodeling of alveolar bone. 3. --- of PDL space. 4. --- change in tooth mobility

Decrease Decrease Narrowing No

Disuse Atrophy

Total removal of occlusal forces resulting in lack of the level of physiologic stimulation required to maintain normal form and function. Physiologic adaptation and not considered pathologic

Clinical Symptoms of Disuse Atrophy (3)

1. Radiographic evidence of decreased width of PDL space. 2. Increased tooth mobility is always present. 3. Absence of occlusal antagonist.

Disuse Atrophy 1. --- of the principle fiber bundles of the PDL. 2. --- PDL width. 3. --- in number of bony trabeculae, i.e., localized osteoporosis

Loss of orientation Narrowed Significant decrease

Trauma From Occlusion Trauma from occlusion, in the absence of inflammation, does not cause: (3)

* gingivitis * periodontitis * pocket formation

The Role of occlusion in the Dental Implant and Peri-implant condition: A Review. Graves CV, Harrel SK et al., Open Dent J 2016, Nov 16;10:594-601 “Several articles demonstrated that occlusion and occlusion overload could detrimentally affect the --- condition, while other articles did not support these results.”

peri-implant

The Role of Occlusion in Implant Therapy: A Comprehensive Updated Review. Sheridan RA, Decker AM et al. Implant Dent 2016 Dec; 25(6):829-838 PubMed database review 1950 to September 2015 * Findings

* Recommendations still lacking regarding implant occlusion but include * Mutually protected occlusion with * Anterior guidance * Wide freedom in centric relation (decrease cuspal inclines) * Reduce occlusal overload (more implants, less cantilevers) * Close monitoring for parafunctional habits

Harrell communication on AAP Forum 2019 Performed comprehensive lit review for textbook chapter on occlusion in the failure of implants most articles were case reports/opinion articles & related to prosthetic failure. Recommend (2)

* Occlusal adjustment (prior to implant restoration) * Hard acrylic bite guard in all cases (or where parafaunctional habits are suspected)

Conclusions Traumatic Occlusal Forces (TOF) * No evidence that this causes --- * Limited evidence (animal and human) that it causes --- * Observational studies that TOF may be associated with severity of --- * Animal model- * Human-

periodontal attachment loss in humans inflammation in the periodontal ligament periodontitis may increase alveolar bone loss no evidence

Traumatic Occlusal Force and Relationship to (2)

1. Non carious cervical lesions (NCCL’s) /Abfraction 2. Recession

Traumatic Occlusal Force(s) and Abfraction NO EVIDENCE that TOF causes

non-carious cervical lesions (NCCLs). Most studies used finite element analysis (not clinical) NCCLs may result from abrasion, erosion or corrosion

Recession

EVIDENCE from observational studies that Traumatic Occlusal Force does NOT cause gingival recession

Abfraction

No credible clinical evidence to support existence of abfraction Therefore there can be no evidence implicating abfraction as cause of recession!

Traumatic Occlusal Forces Flashcards

(60 cards)